Prognostic Impact of Bundle Branch Block After Acute Coronary Syndrome. Does It Matter If It Is Left of Right?
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/3418 |
Resumo: | Background: In previous guidelines, acute coronary syndromes (ACS) with new or presumably new left bundle branch block (LBBB) were an indication for reperfusion treatment, preferably with primary angioplasty. Recent guidelines also included the presence of right bundle branch block (RBBB) in this recommendation. It was our objective to evaluate in a population of patients with ACS the differential impact of RBBB and LBBB in prognosis. Methods: Consecutive patients included prospectively in a single-centre registry of ACS were included in the study. Patients were analyzed according to baseline ECG characteristics (normal QRS, LBBB or RBBB). Primary outcome was all-cause mortality at one-year follow-up. We used Cox-proportional hazards models to assess the predictive value for the primary outcome. Results: A total of 3990 patients were included in, with a mean age of 64 (13) years, 72% males, 3.4% with LBBB and 4.3% with RBBB. Patients with BBB were older, with more previous history of myocardial infarction and coronary revascularization and higher prevalence of cardiovascular risk factors (except smoking). Medical treatment was similar but they were less often submitted to angioplasty. In univariate analysis, BBB patients had worst outcome (Log-rank, p < 0.001), but similar in LBBB and RBBB (Log-rank, p = 0.597). In multivariate analysis, only RBBB (HR 1.66, 95%CI 1.14-2.40, p = 0.007) is an independent predictor of all-cause mortality. Conclusions: Patients with BBB have worst outcome after an ACS, particularly with RBBB. For that reason, we should pay special attention and treat these patients as aggressively as patients with normal QRS duration or LBBB. |
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Prognostic Impact of Bundle Branch Block After Acute Coronary Syndrome. Does It Matter If It Is Left of Right?HSM CARAcute Coronary SyndromesBundle Branch BlockPrognosisBackground: In previous guidelines, acute coronary syndromes (ACS) with new or presumably new left bundle branch block (LBBB) were an indication for reperfusion treatment, preferably with primary angioplasty. Recent guidelines also included the presence of right bundle branch block (RBBB) in this recommendation. It was our objective to evaluate in a population of patients with ACS the differential impact of RBBB and LBBB in prognosis. Methods: Consecutive patients included prospectively in a single-centre registry of ACS were included in the study. Patients were analyzed according to baseline ECG characteristics (normal QRS, LBBB or RBBB). Primary outcome was all-cause mortality at one-year follow-up. We used Cox-proportional hazards models to assess the predictive value for the primary outcome. Results: A total of 3990 patients were included in, with a mean age of 64 (13) years, 72% males, 3.4% with LBBB and 4.3% with RBBB. Patients with BBB were older, with more previous history of myocardial infarction and coronary revascularization and higher prevalence of cardiovascular risk factors (except smoking). Medical treatment was similar but they were less often submitted to angioplasty. In univariate analysis, BBB patients had worst outcome (Log-rank, p < 0.001), but similar in LBBB and RBBB (Log-rank, p = 0.597). In multivariate analysis, only RBBB (HR 1.66, 95%CI 1.14-2.40, p = 0.007) is an independent predictor of all-cause mortality. Conclusions: Patients with BBB have worst outcome after an ACS, particularly with RBBB. For that reason, we should pay special attention and treat these patients as aggressively as patients with normal QRS duration or LBBB.ElsevierRepositório do Centro Hospitalar Universitário de Lisboa Central, EPETimóteo, ATMendonça, TAguiar Rosa, SGonçalves, ACarvalho, RFerreira, MLCruz Ferreira, R2020-02-06T13:20:32Z2019-032019-03-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/3418engInt J Cardiol Heart Vasc. 2018 Dec 3;22:31-34.10.1016/j.ijcha.2018.11.006info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:42:54Zoai:repositorio.chlc.min-saude.pt:10400.17/3418Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:20:43.777463Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Prognostic Impact of Bundle Branch Block After Acute Coronary Syndrome. Does It Matter If It Is Left of Right? |
title |
Prognostic Impact of Bundle Branch Block After Acute Coronary Syndrome. Does It Matter If It Is Left of Right? |
spellingShingle |
Prognostic Impact of Bundle Branch Block After Acute Coronary Syndrome. Does It Matter If It Is Left of Right? Timóteo, AT HSM CAR Acute Coronary Syndromes Bundle Branch Block Prognosis |
title_short |
Prognostic Impact of Bundle Branch Block After Acute Coronary Syndrome. Does It Matter If It Is Left of Right? |
title_full |
Prognostic Impact of Bundle Branch Block After Acute Coronary Syndrome. Does It Matter If It Is Left of Right? |
title_fullStr |
Prognostic Impact of Bundle Branch Block After Acute Coronary Syndrome. Does It Matter If It Is Left of Right? |
title_full_unstemmed |
Prognostic Impact of Bundle Branch Block After Acute Coronary Syndrome. Does It Matter If It Is Left of Right? |
title_sort |
Prognostic Impact of Bundle Branch Block After Acute Coronary Syndrome. Does It Matter If It Is Left of Right? |
author |
Timóteo, AT |
author_facet |
Timóteo, AT Mendonça, T Aguiar Rosa, S Gonçalves, A Carvalho, R Ferreira, ML Cruz Ferreira, R |
author_role |
author |
author2 |
Mendonça, T Aguiar Rosa, S Gonçalves, A Carvalho, R Ferreira, ML Cruz Ferreira, R |
author2_role |
author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Timóteo, AT Mendonça, T Aguiar Rosa, S Gonçalves, A Carvalho, R Ferreira, ML Cruz Ferreira, R |
dc.subject.por.fl_str_mv |
HSM CAR Acute Coronary Syndromes Bundle Branch Block Prognosis |
topic |
HSM CAR Acute Coronary Syndromes Bundle Branch Block Prognosis |
description |
Background: In previous guidelines, acute coronary syndromes (ACS) with new or presumably new left bundle branch block (LBBB) were an indication for reperfusion treatment, preferably with primary angioplasty. Recent guidelines also included the presence of right bundle branch block (RBBB) in this recommendation. It was our objective to evaluate in a population of patients with ACS the differential impact of RBBB and LBBB in prognosis. Methods: Consecutive patients included prospectively in a single-centre registry of ACS were included in the study. Patients were analyzed according to baseline ECG characteristics (normal QRS, LBBB or RBBB). Primary outcome was all-cause mortality at one-year follow-up. We used Cox-proportional hazards models to assess the predictive value for the primary outcome. Results: A total of 3990 patients were included in, with a mean age of 64 (13) years, 72% males, 3.4% with LBBB and 4.3% with RBBB. Patients with BBB were older, with more previous history of myocardial infarction and coronary revascularization and higher prevalence of cardiovascular risk factors (except smoking). Medical treatment was similar but they were less often submitted to angioplasty. In univariate analysis, BBB patients had worst outcome (Log-rank, p < 0.001), but similar in LBBB and RBBB (Log-rank, p = 0.597). In multivariate analysis, only RBBB (HR 1.66, 95%CI 1.14-2.40, p = 0.007) is an independent predictor of all-cause mortality. Conclusions: Patients with BBB have worst outcome after an ACS, particularly with RBBB. For that reason, we should pay special attention and treat these patients as aggressively as patients with normal QRS duration or LBBB. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-03 2019-03-01T00:00:00Z 2020-02-06T13:20:32Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/3418 |
url |
http://hdl.handle.net/10400.17/3418 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Int J Cardiol Heart Vasc. 2018 Dec 3;22:31-34. 10.1016/j.ijcha.2018.11.006 |
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info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Elsevier |
publisher.none.fl_str_mv |
Elsevier |
dc.source.none.fl_str_mv |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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